Interview with Tom Campanella, J.D., M.A. of Baldwin Wallace University (Part 1): Primary Care & Rural Health Challenges

Is the U.S. healthcare system failing to prioritize what truly matters? Join us in an eye-opening discussion with Thomas Campanella from Baldwin Wallace University, as we dissect the multifaceted challenges facing the primary care sector. With a staggering 40-year experience in healthcare, Tom sheds light on the dire shortage of primary care physicians and the frustrating economic dynamics that undervalue this essential field. Despite the U.S. spending nearly 20% of its GDP on healthcare, only a small fraction goes to primary care, a discrepancy that Tom believes is starting to gain overdue recognition through innovative collaborations and a push for quicker changes.

We dive into the complex economic and political landscape that hinders primary care, revealing how vested interests and profit-driven motives perpetuate a system focused more on treating illness rather than preventing it. As we navigate through the intricacies of value-based care, Tom highlights the growing impact on primary care provider compensation, especially for family medicine practitioners. By understanding the broader context—payer systems, hospital operations, and policies—we underscore the need for tailored solutions to address primary care issues in both urban and rural settings.

The conversation also ventures into the transformative role of technology in healthcare, particularly in bridging gaps in rural areas. From the rise of telehealth accelerated by COVID-19 to the efforts of retailers like Walmart and Walgreens in making healthcare accessible, we explore a range of innovative solutions. We also discuss the challenges specific to rural healthcare, such as limited broadband access, and the importance of collaborative community efforts. Wrapping up with insights on federal support and successful models of rural healthcare, this episode offers a comprehensive look at the future possibilities in primary care.

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Transcript

Jason Crosby: 0:50

This is Jason Crosby, and welcome to another episode of Beyond the Stethoscope with SHP. I am joined by my cohorts Aaron Higgins, mike Scribner and our special guest today is Thomas Campanella from Baldwin Wallace University. Welcome to everybody and thanks for joining us. Thank you.

Tom Campanella: 1:09

And I really enjoy the company that I will be having over the next, you know, half hour or so.

Aaron Higgins: 1:18

Yeah, we are really excited to have you here, Tom. I know Mike cleared his schedule specifically to join us, so it's kind of a treat we have Mike on here with us as well.

Mike Scribner: 1:29

Absolutely Looking forward to the discussion. I really like the kind of the high-level philosophical parts of it, so let's get going.

Jason Crosby: 1:36

Sounds great. So, tom, you've especially in the Academia Award you've covered so many different topics. You've studied, you've got data come from all directions that we've read and particularly you've done a lot recently in the primary care space and you know we obviously work a lot of primary care physicians. We thought we'd start there and just really want to hear your thoughts and things you've come across regarding various primary care shortages, the other challenges and trends you're seeing. You know here we are halfway through 2024. So get our audience up to speed and what you've been seeing and things that you see coming on the horizon on the primary care space.

Tom Campanella: 2:14

Thank you, jason, but I want to start off just briefly. While I've been in academia for the last 20-some years, in total I really have 40 years worth of experience in healthcare in all sectors, also as an associate dean of a medical school osteopathic which was primarily focused on family medicine and was situated in rural Appalachia, ohio, down in Southeast Ohio. I was on the payer side, as a VP of healthcare finance for Blue Cross Plan, healthcare attorney, healthcare consultant, economist, a little bit of everything. So what I try to do in all my writings, podcasts, and that a lot of it is obviously based on what's happening in the current world, but a lot of it is based on my own personal experience over the last 40 years from different perspectives. And that really really dovetails into the subject of family medicine Because, as I said, as the associate dean of Ohio University's osteopathic medical school, which primarily focused on family medicine in fact this was the late 90s we produced more family medicine physicians than any other medical school in the country from a percentage standpoint, but it was also in a rural area I gained both an appreciation of the value and the importance of family medicine and primary care, but also the challenges in rural America, which I know we're going to be talking about later the bottom line when you talk about family medicine, when push comes to shove, it is probably one of the most ironic and maybe frustrating and challenging subjects because, as everyone knows, we spend more on health care than any other country in the world close to 20% of our gross domestic product and the specialty that is focused on keeping people healthy.

Tom Campanella: 4:28

We approximately spend about 7% of our health care spend on family medicine and primary care. So we really have it backwards and really that's the reason why, when we talk about health care, we really have a sick care system that really treats people and most of our dollars are focused on after somebody is sick, has a health issue, and that, rather than preemptively, focusing on trying to keep them healthy, which is the ultimate focus of primary care and family medicine. Have you?

Mike Scribner: 5:06

seen that start to shift recently. It kind of feels like in our world we're a little bit late to the game in this section of the country, but nonetheless it does feel like that the boat is beginning to turn. What is your experience?

Tom Campanella: 5:23

Yes, I definitely see it moving in what I would call the right direction, but at the same time, it needs to be done in a much more accelerated way. I think what's happening is and we know this, and this is a subject in itself all the disruption that's occurring in healthcare, with all the different players coming from all different ways. I think that's opening up opportunities for you know, different players, including health insurance companies, analytical companies, and that to sort of partner hire, come up with creative collaborations with family medicine and primary care, which is then creating more opportunities for family medicine and primary care and hopefully is incenting the medical students to go in that direction, which really should be the long-term goal. But I've had the opportunity to I speak on a number of different topics, different audiences, but one of the most interesting is I actually speak to medical students and family medicine residency programs in different parts of the country and I'm starting to see a little bit more steam, a little bit more hope, much more money than with the.

Tom Campanella: 7:01

You know, the value that they can and are providing versus what we pay them, versus other specialties, is really, you know, basically a crime. And then the other thing is we, the burden we put on primary care physicians ultimately is causing a lot of burnout. So at one end, we're starting to get more in, but the other big challenge, Mike, is we have a lot of physicians that are in family medicine, primary care, that are in their 60s and they'll be retiring, so we really got to ramp it up. You know we talk about World War II analogies, especially with D-Day and that, and we really need a Marshall Plan, as they did in Germany, and everything else for primary care from a country standpoint. So that's where I'm at, so we're going in the right direction, but it needs to be accelerated big time.

Aaron Higgins: 7:54

So, Tom, kind of going back to the point you raised about needing to be more proactive versus reactive in the sort of care that we're giving, that seems to me to be more of a cultural problem rather than one that we can throw dollars at.

Tom Campanella: 8:12

How do you think we could overcome that? Aaron is? The culture aspect is, bluntly, we have to change the mindset in the US to get individuals much more engaged in their own health, because, when we compare ourselves to other countries, one of the reasons why we may not have the best outcomes is bad lifestyles and other types of things, and we need to get them more engaged in their health. That's where, again, I really think having family medicine and primary care much more robust, including with their staff and using technology in that can be a way to educate and engage the patient in their own care much more than it is today and maybe from a family standpoint especially when you're talking about seniors and others getting them much more involved in that individual's care or, you know, getting on top of them and whatever's needed. But there is a lot of that going.

Tom Campanella: 9:19

The other part of it is, let's face it, when we talk about 20% of our gross domestic product being spent on healthcare, we may perceive that as a cost, but a lot of stakeholders are looking at that as revenue and profit, so they make a lot of money on our current sick care system.

Tom Campanella: 9:40

That bluntly devalues primary care. So part of the challenge we have, even in Washington DC, is politically, is that a lot of these players are in effect. You won't see them out in the public, but behind the scenes, these lobbyists and everything else are protecting their little piece of the pie really big piece of the pie to the detriment of primary care. So that's when you say why can't we do more? This is so obvious. I mean, you could put a bunch of high school students together and they can come to the conclusion of what needs to be done. But you know, as you know, the name of the game is follow the dollars, and there's a lot of dollars being spent on. You know, once a person is sick and I hate to say it, it sounds terrible, but that's an issue culturally, from a societal standpoint, we need to address issue culturally, from a societal standpoint we need to address.

Mike Scribner: 10:42

It does seem like, at least to a small degree, that as the value-based component has become a bit larger, that that's driven up primary care providers' salaries to a certain degree. I feel like I'm sensing in our market that if you wanted to recruit primary care to a rural market five years ago, even 10 years ago, for sure they're going to be employed by the local hospital because they can't make it on their own individually of value-based care somewhat successful versions of it out there, it's driven up the compensation for primary care to a certain degree. Are you seeing that nationally and is there any sort of leverageable part of that that can be replicated? That is a larger solution than just market by market.

Tom Campanella: 11:35

Well, first of all, I am seeing that nationally, mike, and it's back to what we learned in school supply and demand, and right now we have that limited supply of primary care docs. But there is a recognition in a value-based world that we're trying to transition to, with multiple stakeholders, including for-profit and non-profit. Getting involved is, as you get more players, bluntly, the family medicine position has more leverage. They do have options and, as you know, in the non-healthcare world, when you have options, you're in a position where you have the ability maybe to control and demand higher compensation, a better quality of life, that type of thing. So I definitely see that coming and it is starting to come in different areas of the country to different degrees, you know, not just regionally, but urban, rural and everything else. There's obviously a lot of other factors.

Tom Campanella: 12:40

You can't look at it. You know. An analogy that we talked about earlier, mike, really applies to family medicine as well as other subjects in healthcare. I look at it like a piece of a puzzle. You can focus on one piece, say family medicine shortage, what can be done, but if you just isolate just on that piece and your knowledge base is just focused on that piece, you're never going to really understand the challenges but, more importantly, find the answers. You got to look at all those other pieces that sort of come together. So you got to have a better understanding of what's happening in the payer world, the hospital world, overall state and national health policy, the different types of payment methodologies, what's happening in for-profit. So you have to have that appreciation.

Tom Campanella: 13:31

But just like a puzzle, once you have that grasp of that, you're in a better position to both locally and regionally and nationally, going back to your pilot programs and that, to put pieces together and say, hey, I think we found a solution if we put this piece together with that piece and everything else, with these stakeholders state or whatever else involved in it, getting the payer side, whatever it happens to be. But each region, including urban, rural, region of the state or whatever does not necessarily have the same solution. What makes sense in Montana may not make sense in New York City. Obviously we went through this with COVID and everything else. You just can't have, can't have across the board thing. You know there's issues going on in each region. So there really needs to be almost like a ground-up approach to a national approach, but a ground-up approach to address some of the challenges in family medicine and primary care.

Aaron Higgins: 14:34

Let's take a quick break. We'll be back in just a moment.

Julia : 14:38

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Jason Crosby: 15:10

Tom, you mentioned a couple of things. I'd like to follow up on One. In terms of the provider base, you've got the aging population that you mentioned before, and then the younger group that's coming up and maybe not filling that gap number-wise or pay-wise. Then you also mentioned technology.

Jason Crosby: 15:27

Aaron and I have talked about a few different topics that kind of maybe fits in that vein in terms of provider gaps that exist, right, and from the provider side, you've got utilization, perhaps of mid-levels that haven't been utilized as much as they could. Or, in particular last year, we've talked a lot about retailers, right, whether it's the Walmart, walgreens, dollar General, even that at least are a little bit more in the accessibility space than anything else. Then, on the IT, you've got telehealth that really took off from COVID and of course, ai. That's really been a hot topic. I'm curious I know I just threw a few different kind of things at you there but those items, whether it's the provider side, like mid-levels, or the IT side, like telehealth, how they may be of some benefit to this gap that exists over these coming years, or maybe what you're seeing nationally that maybe those can provide a relief to that gap.

Tom Campanella: 16:26

Well, I definitely think, just like it would in other areas, the effective use of technology can allow things to become more efficient, to be able to do things in a sort of more focused and productive way. Let's talk about telehealth, for an example. You know telehealth has been, you know, was really starting to ramp up prior to COVID. Obviously, covid accelerated it big time. I actually wrote an article, a blog, back in 2018, which was obviously two years before COVID really hit about. I called it care in the home, setting the new frontier of health care, and I saw that trend, which now everyone's talking about hospitals at home or whatever. But I wrote what I thought was a reasonably good analytical reason, going back to the pieces of the puzzle, how the different factors that resulted in maybe caring the home setting playing a key part. Ultimately, just as an aside and that will fit into this discussion, is that I knew the payer side both the government and commercial, and employers were, and self-insured employers were trying to drive healthcare costs, especially because escalating to the lowest cost setting. But it needed to be a safe setting. And the number two thing is I also recognized that what was happening in the hospital world, which also results in why we have a lot of competitors is this trend again has been occurring for a number of years prior to COVID is inpatient admissions across the board have been going down throughout the country on the hospital side. But what's happening is the ones that are going into the hospital have more high-risk factors. So in many ways in hospitals, especially in major urban areas, are almost becoming like giant ICUs, intensive care units, because it's really focused on the high risk. Where are these patients then going? Well, they're going to the outpatient world, which we've been seeing that for a number of years, but that's accelerating. And, by the way, this is a challenge for a hospital because on the inpatient side, when you think about it, how many competitors do? They have Just a few other hospitals. But on the outpatient side, you know you could have niche players, big players, whatever it is, regional, national players.

Tom Campanella: 19:05

But then when you think about the lowest cost setting, I was thinking God, care in the home setting. But to do that it's a chicken and egg phenomena. You can't have care in the home setting from a safety standpoint, unless you have to be able to provide it. You need technology, you need medical device and everything to both provide it, to both monitor it, diagnose it and everything in that home setting. But where the chicken and egg comes in, think about it.

Tom Campanella: 19:36

If you're a technology company, if you're into virtual care, if you happen to be a medical device company, you're not in it because you know I hate to say it altruistically you're there to make money. You have research and invest in it. So the only way you're going to pay for it is if you know there's a long-term trend that payers are going to pay for it. So that's where the synergy comes in. The chicken and the egg. Payers are saying we want to drive it to the lowest cost setting and we're willing, but it's got to be safe. And then, at the same time, medical device technology, including telehealth, is saying we're willing to do this and invest in it to make it user-friendly, but we've got to have a long-term revenue source for it. So you got that synergy occurring. So telehealth what's so great about that is not only is it the ability to be able to do it within a home setting, for an example, but also which we really haven't done enough of. You know we talked about patient engagement and those types of things between visits to better engage that patient, plus their family members into whatever health issues chronic health issues that are having can be a great vehicle to be able to, you know sort of find a way to keep people healthy and everything else. So there is a lot of that advancement.

Tom Campanella: 21:13

Where the challenge is is one of the you know topics that you know I find really important is rural health care, which you're very familiar with, and when you talk about broadband and other areas, that's where you have a potential opportunity with telehealth.

Tom Campanella: 21:32

But depending on the rural area, you may not have access to it or the people may not be able to afford you know the technology costs or whatever it happens to be, or they may not have you know they may have issues just being able to grasp. You know the ability to be able to use you know technology in a more effective way. So you got to also be able to address that. The good news there is and aside is just last year there were billions of dollars set aside for a broadband expansion throughout the country, with the major focus being in rural arenas. So there is a recognition. So hopefully that will allow that vehicle to become even more important, and I definitely think nurse practitioners, pas, you know all these other ones can be a great vehicle to help complement the primary care family medicine physician in those environments.

Mike Scribner: 22:42

I get that. My next question is going to, admittedly, come across from a very biased we represent nothing but providers point of view. However, in that whole discussion that you were just having, what I find is one of the issues that we always run into is that the business case from the perspective of the local provider in the rural market is tough to get in telehealth because of the lack of payer support for it and in a lot of ways we sense that the payers are less creative, maybe less in cinema. I don't know what the answer is to fully support that tenant, that we're going to move into the lowest cost setting, and that becomes more of a barrier than anything. Again, I see we see world, the world, from a very, very small lens. But what's your perspective around that? Have you since that, or is that? Is that our payers across the country more receptive and more supportive and you know and facilitating that deeper in?

Tom Campanella: 23:40

other places. Well, I think, mike, like anything else, it's hard to make across-the-board generalization because it depends on the payer, it depends on the region, those types of things. I see them being, At least verbally and this is always a challenge, what you say and what you do and verbally supporting expansion of telehealth. You know, even through federal and state legislation and rules and policy, there's really putting more pressure on them to get more involved in things like telehealth, addressing social determinants. You know, really finding ways to sort of address whatever barriers there are to provide better health care. You know from that standpoint. You know they always say it takes a village or whatever. But you know if you're talking about rural areas and you're talking about smaller providers, you cannot. You know we do business plans and everything else in the academic world. As you said, if you really did a dollar and cents return on investment type situation with some of these rural hospitals for example, you know you're just not getting that return on investment because you don't have enough people. You know the specialties in that. Can you keep an ER open when you only have X number of people? How do you handle and pay for specialists or others, if you know if there's travel issues in that. So that's where it really does have to be. That's why I mentioned things like Marshall Plan, not just for family medicine, but even things like rural health care. That's where you know you got to get employers involved, you got to get the government involved at state level and the federal level. There definitely needs to be additional compensation.

Tom Campanella: 25:58

What I didn't like, bluntly, is, for an example, the COVID part. I know there's a lot of issues politically and I'm not going to go into that, but when it came down to giving money out to different players after COVID hit and there was money given to hospitals, for an example, but a big share of that money went to the big major hospital systems in the big urban areas and from my standpoint they shouldn't have gotten it. You know they have the ability to survive through that thing. What was not done is they should have been narrowly focused on those small hospitals, those rural hospitals. That's where the money was. Covid hit the rural areas more than urban areas, and I'm not saying that there wasn't challenges in the inner city because of COVID, but the point is we should have been directing it to there.

Tom Campanella: 27:00

Problem is the small rural hospitals don't have the political lobbying force, even with the American Hospital Association, than the big urban centers. So that's part of the challenge that you have there and so it really needs to be coming from different sources. Employers, especially self-insured employers, are key, but where the challenge is, as you guys also know, is that one of the challenges, including after COVID, there's been an erosion of employment opportunities in rural areas, which is one of the reasons why we have so many challenges there. So it's not like we can say, okay, employers, you know you need to help subsidize this telehealth, or you know you need to financially support that rural hospital. You know the small hospital and that A lot of them are leaving.

Tom Campanella: 27:53

And that's where I think you know, even with the big urban hospitals, I think there should be some form of I'm not a big believer in tax, but the bottom line they need to help support. We're part of the United States and we need to address it, and I don't care if you live in an urban area or whatever, or a major player in urban, including an employer or whatever. There needs to be some form of financial support for providers in our rural parts of the country, and I grew up in the inner city of Cleveland, so it's not like I'm a small town rural guy and I don't care about it, but the bottom line I saw and I continue to see in my talks and in my visits in rural America, it's not just healthcare, it's a quality of life issue.

Aaron Higgins: 28:58

Instead of the Marshall Plan, we need the Capanella Plan for tackling this.

Tom Campanella: 29:05

Yeah, hey, actually, you know it's funny.

Tom Campanella: 29:09

You know, way back when in my 20s I was a Cleveland City Councilman and I quickly discovered that even though I was altruistic, passionate and everything else, it was the political side was not me, you know I, you know, I played a lot of sports and I had so many times people coming up to me in politics you got to play ball, or I knew I was not meant for politics when I was starting to tell my mother and she would ask for help and I'd say, well, what's in it for me? So I'd rather, when I write and publish or speak I never know, am I doing it from an educational standpoint or a venting standpoint? Because it really is frustrating to see this country and what we spend on health care and to have some of the discrepancies as we talk about. So, on a personal basis, I'm 74 and I don't plan on giving up and I plan on, you know, God willing being involved in one way or another in health care advocacy and policy, on things like family medicine and rural healthcare for hopefully, many, many years.

Aaron Higgins: 30:25

We'll be right back.

Ami: 30:28

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Mike Scribner: 30:52

So all government help and Marshall Plan Campanella Plan aside, marshall plan Campanella plan aside, what successful models are you seeing rural health care where they are? You know local providers, local health systems, whatever have stepped up and are you know taking innovative approaches. What are those things? What does the right direction look like from a rural provider's world? Now Forget the Calvary running in to help. What are they doing themselves?

Tom Campanella: 31:25

Well, first of all, as they always say, god says you got to help yourself first. So, in other words, it really the community needs to be involved and they need to be a catalyst for a lot of this. And you know just as an aside for a lot of this, and you know just as an aside. Again back to personal experience, back in the 90s in Southeast Ohio nine counties you talk about a very rural area, some of the poorest areas, not only in the state but in the country I got elected. Besides the role of associate dean and doing population health, I was over a collaborative of different stakeholders that were working together to address the type of issues we're talking about in that region of the country. So, for an example, in my role I was in a position where I had access to health care, mobile health care clinics. Back in the 90s they actually reported under me as part of the medical school role. So we were out there in the communities, but we also worked with the Department of Health, jobs and Family Services, the local hospital, the different types of the school system, because health care starts, you know, in grade school, you know in different ways and we basically said you know, we are all back to the puzzle, play a certain role within this region, but we're doing it in silos. We need to work together. We need to actually put together a collaborative to work together, and then we looked at getting funding from Robert Wood Johnson to help out. You know, from that standpoint, you know the state and everything else, we were addressing issues like licensed schools. You know which was a major cause of absenteeism, for an example, but we had to come at it from a different direction, for an example, but we had to come at it from different direction.

Tom Campanella: 33:21

Where I'm laying that foundation is I saw the potential back in the 90s and what I'm starting to see in different parts of the country and I don't have them all in front of me, but you could actually Google to find out but, like in the state of Washington, for example, and others, they have collaboratives that are working. A similar type of perspective where you get local players taking ownership and that would include the employer side too, obviously and the local hospital working together, finding ways to do things in a much more efficient way, but identifying and prioritizing the major issues and then coming at it together. You can imagine if it's a collaborative you have politically and everything else. Also more leverage with the local politicians, but also within the state capitol, and then hopefully finding ways to be able to get the congressmen and senators involved in doing things, so that, I think, is sort of the ground-up approach in it. You've got to have leaders in the community taking ownership, not just recognizing that we just can't have our hand out. The good news is I always found including my own experience people from small communities don't have the attitude of looking for handouts. I think most of them, from what my experience was that they really, if anything, had issues with that and wanted to take things on their own. So I think there is that motivation they may need and we're starting to see this.

Tom Campanella: 34:56

The federal government is working and they have planning grants for an example, which I think is great. So, for an example, you may have a community in Georgia or wherever and they're wanting to do this, but there's infrastructure issues or technology or how do we get these players to work better together? There are federal grants available that might be able to help with some of the backroom stuff to allow this collaboration, you know, so that when you're working on a family, say, you know you got to worry about HIPAA, you know in or something like that, but multiple agencies are involved in it it might even be with the same family or that there should be a linkage of information and data to have more of a comprehensive approach. So I think the collaborative approach, with assistance from the state and federal government and others, is, I think is an effective way to be able to have that ground-up approach.

Aaron Higgins: 36:02

So you're talking about changes to HIPAA potentially as a part of this, and I agree with you. I've been the HIPAA wonk for most of the organizations I've worked for in the last 20 years and it's both a barrier and a protector. So I guess maybe expand on that a little bit. I'd be curious to hear how you would see that sort of change play out, because I think you're right, it's one of those things that's potentially hindering care.

Tom Campanella: 36:34

Well, I remember I was teaching a class I was in health economics when the HIPAA laws came out and one of the problems we have is like a pendulum. You know we have an issue and we go all the way to one direction or all the way to the other direction instead of finding the right direction. It's almost like we work off of you know polls, you know who's. You know it's a political arena, let's face it. You know it's a political arena, let's face it. So you know, the whole idea of HIPAA obviously is protecting the individual's privacy from a healthcare standpoint. On the other hand, in protecting that, it ultimately is an inhibitor of communication between providers.

Tom Campanella: 37:17

Covid was a perfect example where in communities urban and rural, for an example you may have people that had multiple health issues, seeing multiple different providers, including mental health providers, and they may also be in a position where they're going to local community health centers or whatever. And then we're trying to address initiatives and identify these people and determine what's best we can do both individually and as a group. But if the players can't communicate with each other because HIPAA is a barrier, then that's where it gets really challenging. But it can't be administrative burdensome, but some type of release on a more general basis that allows for this type of communication and education. From that standpoint, and while at one end maybe it should be individual, on the other hand that could be really bogged down. There just needs to be that fine line and I think if you got the right people in the room that understand the issues, solutions can be done. It's just a matter of just bringing them up to the table. You know, from that standpoint, I'd be curious.

Jason Crosby: 38:34

you've touched on both kind of a cultural mindset and rural community, but also some legislative action that could be taken. You know we've had REH here recently Rural Emergency Hospital Hopefully I got that acronym right. That's taken effect but we've seen a slow adoption of that for various reasons. 340b, what swing bed program, having that thing, and of course those are big hindrances to a rural hospital being able to take that on. Do you feel such legislation is one, a big piece of the puzzle you were just talking about, and two, removing those little pieces like 340B may just further adopt such a model that would be acceptable to the communities in those rural hospital settings.

Tom Campanella: 39:19

Well, first of all, this goes back to my argument before in regards to the COVID quote bailouts to the hospitals, for an example, where it should have been going to the small hospitals or rural hospitals and a big chunk of it went to the very profitable major urban hospitals. Well, it's the same thing with 340B. I mean, the whole theory behind that was, you know, to be in a position to be able to target, you know, individuals and hospitals that are providing care to, in effect, the people that really need it, the poorer people, the uninsured, those types of things, the people that really need it, the poorer people, the uninsured, those types of things. And next thing, you know every hospital in the world is getting a chunk of 340B and then they're upcharging it and everything else that should be narrowly focused on certain hospitals, especially small, urban, rural hospitals. You know, from that standpoint, and that's an example of redirecting resources for the right reason, you know from that standpoint, and that's an example of redirecting resources for the right reason. You know from that standpoint. So, and then the whole idea of emergency hospitals, and you know, ultimately focusing on that, as well as you know, the effective use of different for-profit players that are out there Walmart's been in healthcare Now I don't know what's going on with them because they were in, then they're out, who knows?

Tom Campanella: 40:49

But you mentioned Dollar General for an example. Dollar General actually has I know they experimented in Tennessee mobile health vans in which they were putting on their sites and others to be able to address it and hopefully go out to the communities too. And I know Dollar General is all over the place in rural America and there may need to be more involvement with players like that there to be able to address it. In regards to the different models, like anything else, it's not one size fits all. I mean, there's pros and cons and the devil's in the detail in regards to some of the options that they're throwing out there, including the emergency type hospital settings, type hospital settings and that, and I'm still in the process of evaluating some of these things, so I'm not in a position to really get that specific.

Aaron Higgins: 41:48

Thank you for joining us today, boy. We just it feels like we just barely scratched the surface. We would love to have you back. I think there's a whole lot more to talk about and be able to pick your brain some more, and I guess I'll speak on behalf of Jason and Mike. We really enjoyed today's conversation, so thank you for joining us.

Tom Campanella: 42:09

Thank you and I really enjoyed this and, as you can tell, I'm not short of words but hopefully they're impactful. But feel free to reach out to me on multiple topics. I enjoy talking about it and you know, and hopefully we can continue this relationship.

Aaron Higgins: 42:29

Yeah, and where can our audience find you if they want to reach out?

Tom Campanella: 42:34

Probably the easiest. Well, first of all, definitely reach out on LinkedIn under Thomas or Tom Campanella, and that's where all my publications are posted, actually including podcasts. Hopefully we can work it out where this podcast I can post it, on health care recap, which I hopefully will have the links from this podcast to send it to about 8,000, 9,000 people too. And so that is the one way. The other way is, you know, strictly by email. It's real simple TCAMP, t-c-a-m as in Mary, p as in Paul, and B as in boy W as in Wallyedu. So that's my email address tcamp at B-W dot edu.

Aaron Higgins: 43:26

Okay, all righty. Well, thank you for tuning in today and we look forward to having you back.

Tom Campanella: 43:31

Okay, thanks, guys, appreciate it.

Aaron Higgins: 43:36

This has been an episode of Beyond the Stethoscope Vital Conversations with SHP. If you enjoyed this podcast, please be sure to rate and share it with your friends. It sure helps the show Production and editing by Nala Weed.

Jason Crosby: 43:50

Social media by Jeremy Miller.

Aaron Higgins: 43:52

And our co-hosts are me, aaron C Higgins and Jason Crosby. Our show producers are Mike Scribner and John Crew.

Jason Crosby: 44:00

Thank you for listening and we'll see you next time. Aaron and I like to always save the best question and the hardest question for last. Oh thanks, yeah, yeah, but given where you're located, I think I already know the answer. It's a popular recent debate who really is the GOAT? Is it LeBron or Georgia? Or write and vote.

Tom Campanella: 44:27

Oh, I'll tell you, yeah, it's a matter of perspective. Obviously, from a Cleveland standpoint, it's also a matter of perspective. We had one perspective of LeBron in 2016 when we won and another one when he moved to Miami. So that perspective changes a lot too. And I have to admit Jordan, being a Cavs fan in the 90s, we had an unbelievable team during that period with Mark Price and Doherty and Nance and those guys, but that Jordan you know so many times prevented us from going. And just a quick story, by the way, I was actually in Chicago at a sports bar in the 90s when we lost to Chicago, when the shot they keep talking about, and you know, and I was in a bar and I was giving all the Chicago fans a hard time because we beat the Bulls six times during the regular season. And then the shot comes along and everybody forgets those six games. If I hear that word, the shot one more time or the drive or the fumble, or whatever, come on guys.

Mike Scribner: 45:50

We all know he pushed off, though it was an offensive foul. What are we doing? What are we doing. Yeah right, tell me about it. Call the foul ref.

Aaron Higgins: 45:57

Oh Tom, it was hard to be a Cleveland fan period during the 90s. All the heartbreak.

Jason Crosby: 46:03

All the heartbreak. I love that you brought up the fumble. That's great yeah don't go there.

Tom Campanella: 46:09

I brought it up, so who am?

Ami: 46:11

I.

Tom Campanella: 46:11

Mea culpa.